Disparities in Time to Care for Pancreatic Cancer

background: Pancreatic cancer is associated with dismal outcomes due in part to advanced disease at presentation, thus early detection and expedited specialty referrals are crucial for effective treatment. Research is lacking on the challenges that arise in seeking a specialty referral, particularly in those patients who are poor and potentially underinsured.

methods: We conducted a retrospective analysis of patients who were seen at our cancer center from March 2011- July 2014. 75 charts were extracted and divided into private versus Medicaid insurance.  Time to specialty care was defined as time of symptom onset to date patient was initially evaluated by a surgical or medical oncologist at the cancer center. Analyses were conducted using Kaplan-Meier methods and statistically significant differences were tested for using the Wilcoxon test.

results: 48 patients were classified as private insurance and 27 as Medicaid. Median age in each group was 60. Baseline sociodemographic characteristics for each group were similar. The most common presenting symptoms in both groups were pain, weight loss, and jaundice. The median time to care in the private group was 9.8 weeks and in the Medicaid group 19 weeks, p= 0.0188.

conclusions: At our institution Medicaid patients with pancreatic cancer were faced with a significantly longer delay from symptom onset to oncologic evaluation compared to those with private insurance. Findings could potentially inform design of an intervention to reduce delay in care with the ultimate goal of impacting survival.